Surgical Volumes in a Regional Trauma Center: Is It Enough?

Purpose@#This study evaluated the surgical volumes and types of specific surgical procedures in a single trauma center for 3 consecutive years. @*Methods@#From January 2014 to December 2016 there were 9,530 injury cases in the trauma registry that were reviewed. @*Results@#There were 1,502 patients (15.8%) with an injury severity score over 15, of which 426 (28.4%) underwent an emergency operation or had an interventional radiology procedure. There were 186 craniotomies, 87 laparotomies, and 74 interventional radiology procedures performed. @*Conclusion@#The number of emergency operations by each dedicated trauma surgeon was very low therefore implementation of an acute-care surgery model is appropriate to consider together with changes to the training program for trauma surgeons.

Surgical Volumes in a Regional Trauma Center: Is It Enough?

Purpose@#This study evaluated the surgical volumes and types of specific surgical procedures in a single trauma center for 3 consecutive years. @*Methods@#From January 2014 to December 2016 there were 9,530 injury cases in the trauma registry that were reviewed. @*Results@#There were 1,502 patients (15.8%) with an injury severity score over 15, of which 426 (28.4%) underwent an emergency operation or had an interventional radiology procedure. There were 186 craniotomies, 87 laparotomies, and 74 interventional radiology procedures performed. @*Conclusion@#The number of emergency operations by each dedicated trauma surgeon was very low therefore implementation of an acute-care surgery model is appropriate to consider together with changes to the training program for trauma surgeons.

The repair of umbilical hernia in cirrhotic patients: 18 consecutive case series in a single institute

PURPOSE: Traditionally, the surgical repair of umbilical hernia in cirrhotic patients with ascites is avoided because of a significant recurrence rate and perioperative morbidity/mortality. However, recent reports recommend early elective surgery in these patients because surgery-related complications can be reduced with minimally invasive surgery and development of perioperative patient care. The current study was conducted to analyze safety and feasibility of umbilical hernia repairs performed in a single institute. METHODS: A single center retrospective analysis of patients' data was conducted. Eighteen patients with umbilical hernia accompanied by liver cirrhosis underwent hernia repair in the period between 2005 and 2012. The charts of these patients were reviewed and demographic data, postoperative complications, and recurrence were recorded. RESULTS: Eleven males and seven females with a mean age of 62.9 years were analyzed. Two of the patients were classified as Child's class A, 11 as Child's class B, and five as Child's class C. Four patients underwent emergency surgery because of perforations in the hernia sac in two cases and incarcerated hernias in the other two cases. Of the 18 patients who underwent surgery, four (22%) experienced a recurrence, three (17%) developed edema at the surgical sites, one (5%) experienced hepatic coma, and one (5%) showed postoperative variceal hemorrhage. All of these events occurred after emergency surgery. CONCLUSION: In contrast to traditional concepts, early and elective repair of umbilical hernia can be performed easily and safely in cirrhotic patients.

Mortality and Morbidity in Severely Traumatized Elderly Patients / 대한구급학회지

BACKGROUND: As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe outcomes from injuries compared with the young. In this study, we examined the relationship between mortality and complications with age. METHODS: This study was a retrospective review of 256 major trauma patients (Injury Severity Score > 15) admitted to an emergency center over a two-year period. Age-dependent mortality and complications were evaluated. RESULTS: Of 256 patients, 209 (81.6%) were male and the mean age was 47.2 years. There was a trend between increasing age and increasing mortality, but this was not statistically significant. Increasing age was correlated with frequency of complications. CONCLUSIONS: Age was confirmed to be an independent predictor of mortality in major trauma. We documented that elderly trauma patients suffer from complications more frequently compared with their younger counterparts. Appropriate and specific triage and management guidelines for elderly trauma patients are needed.